Effect of serotonin-norepinephrine reuptake inhibitors for patients with chemotherapy-induced painful peripheral neuropathy

Abstract

Background: To compare the efficacy of serotonin-norepinephrine reuptake inhibitors (SNRIs) treatment for chemotherapy-induced peripheral neuropathy (CIPN) Methods: Two authors independently searched MEDLINE, Embase, Cochran Library, and Web of Science to identify and review articles published from January 1998 until December 2018 according to selection criteria. Outcomes were expressed as mean difference, the pooled odds ratio, or relative risk in a meta-analysis model. Results: A total of 10 studies were included in this meta-analysis: 6 randomized-controlled studies and 4 observational studies. Meta-analysis showed that CIPN was improved after treatment with SNRI (standardized mean difference = 2.20; 95% confidence interval, 0.90–3.49; I 2 = 93% in 3 randomized controlled studies). Somnolence and insomnia occurred in <15% of patients. Incidence of somnolence was lower than with pregabalin treatment, and insomnia was comparable to that in expectant management or pregabalin treatment. Incidence of nausea and vomiting was higher than in expectant management, but no significant difference was found when compared to expectant management. Conclusion: From the several available studies suitable for indirect comparison, SNRI shows excellent efficacy and tolerability to CIPN. SNRI could provide an important treatment option for CIPN.

Emerging Pharmacological and Non-Pharmacological Therapeutics for Prevention and Treatment of Chemotherapy-Induced Peripheral Neuropathy

“…Due to the incomplete knowledge about the underlying pathophysiology of CIPN, symptomatic treatments have not been consistently successful. It is known that neurotransmitters such as serotonin and norepinephrine are involved in the descending inhibitory nociceptive pathway and can amplify the effects of central sensitization [ 42 ]. Some studies have indicated that serotonin-norepinephrine reuptake inhibitors (SNRI), which inhibit the reuptake of these neurotransmitters and increase synaptic concentrations, can prevent input to the spinal dorsal horn neurons and thereby decrease pain transmission [ 42 ].…”

“…It is known that neurotransmitters such as serotonin and norepinephrine are involved in the descending inhibitory nociceptive pathway and can amplify the effects of central sensitization [ 42 ]. Some studies have indicated that serotonin-norepinephrine reuptake inhibitors (SNRI), which inhibit the reuptake of these neurotransmitters and increase synaptic concentrations, can prevent input to the spinal dorsal horn neurons and thereby decrease pain transmission [ 42 ]. Currently, the only agent that has documented pharmacological activity in the treatment of CPIN is the SNRI, duloxetine [ 43 ].…”

“…Currently, the only agent that has documented pharmacological activity in the treatment of CPIN is the SNRI, duloxetine [ 43 ]. Indeed, a meta-analysis on the effects of SNRI treatment of painful CIPN has confirmed both significant efficacy and safety for this indication [ 42 ]. Based on comparative trials, duloxetine was found to be more effective than venlafaxine in decreasing symptoms of CIPN, including motor neuropathy and neuropathic pain grade [ 44 ].…”

Persistent Breast Cancer Pain

“…Along with providing benefit for post-surgical neuropathic pain, both duloxetine and venlafaxine also offer pain relief for patient's suffering from chemotherapy induced peripheral neuropathy [80,81], and even decrease motor neuropathy symptoms [82]. Benefits of these two SNRIs has been their ability to target multiple concerns, such as depression, anxiety, musculoskeletal pain, and neuropathy [83] and thus should be strongly considered as an adjuvant when formulating a comprehensive pain management plan.…”

Ganglioside-monosialic acid (GM1) for prevention of chemotherapy-induced peripheral neuropathy: a meta-analysis with trial sequential analysis

“…The quality of RCTs was assessed using the Cochrane risk-of-bias assessment tool [20]. RCTs without a high risk of bias in any category were considered as good quality studies; RCTs with one high risk or two unclear risks were considered as fair quality studies; and the rest were considered to be poor quality studies [21]. The quality of each nonrandomized and observational study was evaluated using the Newcastle-Ottawa Scale, which evaluates three factors: patient selection (0-4 stars), comparability of the study groups (0-2 stars), and assessment of outcome (0-3 stars) [22].…”